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Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours

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Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours. / Fakhri, Yama; Busk, Martin; Schoos, Mikkel Malby; Terkelsen, Christian Juhl; Kristensen, Steen D; Wagner, Galen S; Sejersten, Maria; Clemmensen, Peter; Kastrup, Jens.

In: J ELECTROCARDIOL, Vol. 49, No. 3, 08.03.2016, p. 278-283.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Fakhri, Y, Busk, M, Schoos, MM, Terkelsen, CJ, Kristensen, SD, Wagner, GS, Sejersten, M, Clemmensen, P & Kastrup, J 2016, 'Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours', J ELECTROCARDIOL, vol. 49, no. 3, pp. 278-283. https://doi.org/10.1016/j.jelectrocard.2016.02.009

APA

Fakhri, Y., Busk, M., Schoos, M. M., Terkelsen, C. J., Kristensen, S. D., Wagner, G. S., Sejersten, M., Clemmensen, P., & Kastrup, J. (2016). Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours. J ELECTROCARDIOL, 49(3), 278-283. https://doi.org/10.1016/j.jelectrocard.2016.02.009

Vancouver

Fakhri Y, Busk M, Schoos MM, Terkelsen CJ, Kristensen SD, Wagner GS et al. Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours. J ELECTROCARDIOL. 2016 Mar 8;49(3):278-283. https://doi.org/10.1016/j.jelectrocard.2016.02.009

Bibtex

@article{315027ef056e4c609ff3fc77450feb84,
title = "Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours",
abstract = "BACKGROUND: Primary percutaneous coronary intervention (pPCI) is recommended in patients with ST Elevation Myocardial Infarction (STEMI) and symptom duration <12hours. However, a considerable amount of myocardium might still be salvaged in STEMI patients with symptom durations >12hours (late-presenters). The Anderson-Wilkin's score (AW-score) estimates the acuteness of myocardial ischemia from the electrocardiogram (ECG) in STEMI patients. We hypothesized that the AW-score is superior to symptom duration in identifying substantial salvage potential in late-presenters.METHODS: The AW-score (range 1-4) was obtained from the pre-pPCI ECG in 55 late-presenters and symptoms 12-72 hours. Myocardial perfusion imaging was performed to assess area at risk before pPCI and after 30days to assess myocardial salvage index (MSI). We correlated both the AW-score and pain-to-balloon with MSI and determined the salvage potential (MSI) according to AW-score ≥3 (acute ischemia) and AW-score <3 (late ischemia).RESULTS: Late-presenters had median MSI 53% (inter quartile range (IQR) 27-89). The AW-score strongly correlated with MSI (β=0.60, R(2)=0.36, p<0.0001), while pain-to-balloon time did not (β=-0.21, R(2)=0.04, p=0.14). Patients with AW-score ≥3 (n=16) compared to those with AW-score <3 (n=27) had significant larger MSI (82.7% vs 41.5%, p=0.014). MSI>median was observed in 79% in patients with AW-score ≥3 vs 32% in patients with AW-score <3 (adjusted OR 6.74 [95% CI 1.35-33.69], p=0.02).CONCLUSION: AW-score was strongly associated with myocardial salvage while pain-to-balloon time was not. STEMI patients with symptom duration between 12 -72hours and AW-score ≥3 achieved substantial salvage after pPCI.",
keywords = "Electrocardiography/methods, Female, Humans, Male, Middle Aged, Myocardial Ischemia/complications, Myocardial Stunning/diagnosis, Percutaneous Coronary Intervention, Preoperative Care, Prognosis, Reproducibility of Results, ST Elevation Myocardial Infarction/complications, Salvage Therapy/methods, Sensitivity and Specificity, Severity of Illness Index, Symptom Assessment, Treatment Outcome",
author = "Yama Fakhri and Martin Busk and Schoos, {Mikkel Malby} and Terkelsen, {Christian Juhl} and Kristensen, {Steen D} and Wagner, {Galen S} and Maria Sejersten and Peter Clemmensen and Jens Kastrup",
note = "Copyright {\textcopyright} 2016 Elsevier Inc. All rights reserved.",
year = "2016",
month = mar,
day = "8",
doi = "10.1016/j.jelectrocard.2016.02.009",
language = "English",
volume = "49",
pages = "278--283",
journal = "J ELECTROCARDIOL",
issn = "0022-0736",
publisher = "Churchill Livingstone",
number = "3",

}

RIS

TY - JOUR

T1 - Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours

AU - Fakhri, Yama

AU - Busk, Martin

AU - Schoos, Mikkel Malby

AU - Terkelsen, Christian Juhl

AU - Kristensen, Steen D

AU - Wagner, Galen S

AU - Sejersten, Maria

AU - Clemmensen, Peter

AU - Kastrup, Jens

N1 - Copyright © 2016 Elsevier Inc. All rights reserved.

PY - 2016/3/8

Y1 - 2016/3/8

N2 - BACKGROUND: Primary percutaneous coronary intervention (pPCI) is recommended in patients with ST Elevation Myocardial Infarction (STEMI) and symptom duration <12hours. However, a considerable amount of myocardium might still be salvaged in STEMI patients with symptom durations >12hours (late-presenters). The Anderson-Wilkin's score (AW-score) estimates the acuteness of myocardial ischemia from the electrocardiogram (ECG) in STEMI patients. We hypothesized that the AW-score is superior to symptom duration in identifying substantial salvage potential in late-presenters.METHODS: The AW-score (range 1-4) was obtained from the pre-pPCI ECG in 55 late-presenters and symptoms 12-72 hours. Myocardial perfusion imaging was performed to assess area at risk before pPCI and after 30days to assess myocardial salvage index (MSI). We correlated both the AW-score and pain-to-balloon with MSI and determined the salvage potential (MSI) according to AW-score ≥3 (acute ischemia) and AW-score <3 (late ischemia).RESULTS: Late-presenters had median MSI 53% (inter quartile range (IQR) 27-89). The AW-score strongly correlated with MSI (β=0.60, R(2)=0.36, p<0.0001), while pain-to-balloon time did not (β=-0.21, R(2)=0.04, p=0.14). Patients with AW-score ≥3 (n=16) compared to those with AW-score <3 (n=27) had significant larger MSI (82.7% vs 41.5%, p=0.014). MSI>median was observed in 79% in patients with AW-score ≥3 vs 32% in patients with AW-score <3 (adjusted OR 6.74 [95% CI 1.35-33.69], p=0.02).CONCLUSION: AW-score was strongly associated with myocardial salvage while pain-to-balloon time was not. STEMI patients with symptom duration between 12 -72hours and AW-score ≥3 achieved substantial salvage after pPCI.

AB - BACKGROUND: Primary percutaneous coronary intervention (pPCI) is recommended in patients with ST Elevation Myocardial Infarction (STEMI) and symptom duration <12hours. However, a considerable amount of myocardium might still be salvaged in STEMI patients with symptom durations >12hours (late-presenters). The Anderson-Wilkin's score (AW-score) estimates the acuteness of myocardial ischemia from the electrocardiogram (ECG) in STEMI patients. We hypothesized that the AW-score is superior to symptom duration in identifying substantial salvage potential in late-presenters.METHODS: The AW-score (range 1-4) was obtained from the pre-pPCI ECG in 55 late-presenters and symptoms 12-72 hours. Myocardial perfusion imaging was performed to assess area at risk before pPCI and after 30days to assess myocardial salvage index (MSI). We correlated both the AW-score and pain-to-balloon with MSI and determined the salvage potential (MSI) according to AW-score ≥3 (acute ischemia) and AW-score <3 (late ischemia).RESULTS: Late-presenters had median MSI 53% (inter quartile range (IQR) 27-89). The AW-score strongly correlated with MSI (β=0.60, R(2)=0.36, p<0.0001), while pain-to-balloon time did not (β=-0.21, R(2)=0.04, p=0.14). Patients with AW-score ≥3 (n=16) compared to those with AW-score <3 (n=27) had significant larger MSI (82.7% vs 41.5%, p=0.014). MSI>median was observed in 79% in patients with AW-score ≥3 vs 32% in patients with AW-score <3 (adjusted OR 6.74 [95% CI 1.35-33.69], p=0.02).CONCLUSION: AW-score was strongly associated with myocardial salvage while pain-to-balloon time was not. STEMI patients with symptom duration between 12 -72hours and AW-score ≥3 achieved substantial salvage after pPCI.

KW - Electrocardiography/methods

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Ischemia/complications

KW - Myocardial Stunning/diagnosis

KW - Percutaneous Coronary Intervention

KW - Preoperative Care

KW - Prognosis

KW - Reproducibility of Results

KW - ST Elevation Myocardial Infarction/complications

KW - Salvage Therapy/methods

KW - Sensitivity and Specificity

KW - Severity of Illness Index

KW - Symptom Assessment

KW - Treatment Outcome

U2 - 10.1016/j.jelectrocard.2016.02.009

DO - 10.1016/j.jelectrocard.2016.02.009

M3 - SCORING: Journal article

C2 - 26949016

VL - 49

SP - 278

EP - 283

JO - J ELECTROCARDIOL

JF - J ELECTROCARDIOL

SN - 0022-0736

IS - 3

ER -